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What I learnt from joining some patient support groups for plantar fasciitis

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Craig Payne, Oct 22, 2015.

  1. Stanley

    Stanley Well-Known Member

    Hi Dieter,
    The procedure you are alluding to was based on an Egyptian procedure. I remember the lectures about it in the early 1980's. They would make 7 drill holes. 6 in a circle with one in the middle. I know one Podiatrist that was sued for the fracture and there were rumors of several others (this was before the internet). Removal of the spur allows for drainage and there is no fracture risk. Additionally I remember a podiatrist that was sued for not helping the heel pain. When it was noted that the spur was still there, the defense attorney decided it was better to settle. Try convincing a jury that a heel spur does not need to be removed in a surgery to correct a "Heel Spur". You can change the name but a good attorney will ask if this was known as Heel Spur Syndrome.
     
  2. Dieter Fellner

    Dieter Fellner Well-Known Member

    Stanley,

    I'm sure you're right about the medico-legal implications. As I mentioned, the technique is now adapted - presumably fewer drill holes / less risk - but I'm speculating. As an aside though - bad defense attorney if he cannot provide the evidence about the significance of the spur. It's splattered all over the literature. Moreover, very few surgeons treating PF opt to excise the spur. I'd sack the attorney and sue him and get a better attorney with the money. Of course there's some irony in that I'm now less convinced the 'literature' is definitely and always correct about this assumption. There's also a neat MIS technique for heel spur excision.

    The doctor using the bone marrow decompression technique would likely argue he's treating bone marrow edema, as per MRI finding, and not the 'inconsequential' spur ... but I'm not a lawyer ....
     
  3. Dieter Fellner

    Dieter Fellner Well-Known Member

  4. Stanley

    Stanley Well-Known Member

    Hi Dieter,

    Obviously you are not familiar with the US legal system. It is not podiatry arena where there are podiatrists discussing cutting edge studies and theories.

    Let me give you the scenario. You do a plantar fasciotomy for a painful heel. The patient is not better and goes to an attorney.
    He gets some "expert" who doesn't know anything but is only interested in winning for the plaintiff, as his reputation is dependent on it.
    He talks about heel spur syndrome and how the spur has to be removed when he is questioned.
    You go up on the stand and the plaintiff's attorney asks you:
    Have you read the literature on painful heels? You answer yes.
    What is heel spur syndrome? If you explain what it is, then he will say, "Is this the symptoms of the patient?" You have to say yes. If not, he will go point by point and it will be in your chart and you will be shown to be a liar.
    If you say it doesn't exist or the spur is not the reason for the pain, then he will have a book explaining it and have you read it. This makes you look even worse as you don't even know what is in the medical books. You will not have a chance to protest, at this time, but you will when your attorney has a chance to present his case.
    Your attorney presents his case with the best expert in the country. He talks about plantar fasciitis and the fact that heel spurs do not cause pain.
    The jurors are not all college educated and they look at things this way: There is lots of medical mumbo jumbo and one expert says one thing and the other says something else. The book talks about a heel spur that the juror saw on the x rays. The juror thinks that the spur is what is causing the pain because that is the only thing that showed on the x-ray. If the spur was not a problem, then why did the doctor take the x-ray unless it was just to make money? The spur was not taken out. The doctor must have screwed up.
     
  5. Dieter Fellner

    Dieter Fellner Well-Known Member

    Stanley,

    Yes .... and no. I have been in the US since 2009. My wife is a lawyer. Have I endured the legal system personally? No.

    Like I said before, I'm sure you're right about the medico-legal aspects. What follows is mostly horse play. What IS clear about the legal system is this: the more expensive the lawyer the better your chances. ;-)
     
  6. Dieter Fellner

    Dieter Fellner Well-Known Member

    Oh ya ... the omission might well be the failure to realize that not all cases of PF are responsive to mechanical measures. I send out those cases for MRI, when oftentime there is a substantial thickening of the proximal plantar fascia. In other words, now it's a plantar fasciosis more than fasciitis. Treatment has to be advanced.
     
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